Predictive Role of MicroRNAs in the Diagnosis and Management of Patients with Crohn’s Disease: A Clinician’s View

Crohn’s disease (CD), also known as terminal ileitis, has been the focus of gastroenterological diagnostics and therapy for decades. Although significant therapeutic progress has been made in recent years, largely due to an improved understanding of the pathophysiology and evolving treatment strategies for Crohn’s disease, many new antibody-based therapies demonstrate clinical response rates of only 30–50%. Predictive biomarkers for differential therapeutic responses may therefore be critical for personalized treatment selection, but such markers have not yet been clinically validated for the majority of patients treated with prednisone or monoclonal antibodies targeting integrin pathways, TNF-α, or IL-23. In this review, the diagnostic potential of microRNA (miRNA) dysregulation in patients with Crohn’s disease is explored, emphasizing the potential utility of specific miRNA expression profiles in guiding targeted therapy. Notably, reduced expression of miR-29 is associated with planned treatment using ustekinumab (an IL-23 signaling inhibitor), elevated miR-23a levels in inflamed tissue may inform the use of TNF-α inhibitors, increased miR-155 expression is relevant for patients considered for JAK inhibitor therapy, and altered levels of miR-126 and miR-486 may support the selection of vedolizumab. Assessment of these dysregulated miRNAs—such as through comparative profiling in inflamed versus non-inflamed tissue from the same patients—could serve as a predictive biomarker panel to optimize individualized immunosuppressive treatment strategies in Crohn’s disease. We also examine the role of microRNAs in regulating TRP channels and their involvement in the mechanisms of action of selected complementary medicines.